| Objective:Select the post-thyroidectomy cases as research object.By counting through a survey of thyroidectomy time points,the change trend of initial postoperative period of thyroid was constructed.Beyond that,many factors such as operation time,gender relations research,the total guide flow and operation scope was researched to find whether the total measured postoperative suction drainage and.putting in drainage or not have a relationship with the healing of incision.Clinical validation of thyroid patients postoperative was made to test the absorptive capacity of wound tissue was strong,so we can choose whether to drainage and the safety of the catheter uproot time,rapid rehabilitation medicine for thyroid diseases in clinical research and practice to provide the reference.Methods:1.Cases choice:1)Eliminating retrosternal goiter and substernal struma patients is necessary.2)The cases including normal clotting index,preoperative discontinuation of oral anticoagulants to 5 to 7 days reoperation,eliminate female menstrual period were excluded.3)Patients with multiple surgery should be ruled out.4)Eliminate the patients with thyroid in cleaning the postoperative chylous leakage to the cervical lymph nodes.5)If accident such as jams,the drainage tube leakage drainage failure was happended,observation is needed to exclude the cases.6)the experiment is mainly for patients with benign and no lateral lymph node metastasis.2.Operation method(based on 2015 ATA Management Guidelines):1)Classic operation method2)Electrotome and ultrasonic knife was used during surgery.3)After the completed resection of thyroid,wound hemostasis was proceed,and the cavity was placed with drainage,drainage of the 14#a special "T" tube was used.Placed ahead of the trachea,along the incision in the middle of derivation,and fixed on the skin,the remote connection drainage ball,keep continuous negative pressure.4)after 6 h the cold liquid or semi-liquid was applied for the patients,normal food was applied for the next day..5)Observe drainage ball post surgery and keep the drainage unblocked(intermittent kneading tube).3.The experimental scheme(1)Consult standard above to set selection in the first affiliated hospital of Kunming medical university hospitalized cases between May 2016-December 2016 of thyroid diagnosis and treatment center,cases can be divided into two groups,respectively for drainage and drainage group.According to the length of time according to the random sequence grouping,drainage of singular as not to put,the bottom for drainage.Group of putting drainage contains 60 cases,not puting drainage group caontain 44 cases,dropped out group contain 10 cases(due to changes in operation,intraoperative put check blood meal,etc and exit into the group).Putting drainage group:Time counting was began after closing the incision,every 20 min with measuring cylinder record one drainage in the ball,drain the total observed 8 hours,remain low pressure suction drainage ball.Based on study of security before I centers tube drawing for 8 to 12 hours,pull out the tube after 12 hours.Records time flow,patients with basic information and disease,and the statistical data reported.(2)Put the patients ofdrainage according to the operation time into:1 hour and 8 cases,1 to 2 hours or less 48 cases,4 cases of 2 hours or more.The average total guide flow of each group was countd by one-way ANOVA statistics.Operation time and total flow relationship was induced.(3)Put placed drainage tube group of patients divided into two groups,male,female 14 cases of male group,female group of 46 cases of statistical gender and the relationship between average total guide flow(4)Put placed in accordance with the extent of surgical drainage of patients divided into 10 groups,respectively,the lymph node is on the right side of the cutting + on the right side of the central group 13 cases;Double side cut + double side central lymph node cleaning group 28 cases;On the left side of the cut + on the left side of the central lymph node cleaning group 6cases;Bilateral whole cut + on the right side of the central lymph node cleaning group 4 cases;On the right side of the cut set in 1 case:All double side cut set of 3 cases:On the right side of the + on the left side of the part excision group 1 case;On the left side of the cut + bilateral central lymph node cleaning group 1 case;On the right side of the cutting + on the left side of The Times all cutting + bilateral central lymph node cleaning group 2 cases;Bilateral whole cutting + on the left side of the central group lymph node cleaning in 1 case.Statistical scope of operation and the relationship between the average total guide flow.(5)Put placed drainage of drainage group and not placed wounds effusion of the case,and will not put drainage according to operation time are divided into groups within 1 hour,1 to 2 hours,2 hours or more group,operation time were compared with wounds effusion.Finally placed drainage of each group of operation time of effusion drainage of situation and not placed in each group are overall operation time of effusion.Results:1.The explore of risk tube drawing point According to the data before experiment,Wounds effusion quantity decreas gradually in 8 hours after surgery drainage,about 80 minutes on postoperative drainage of'liquid lead appeared a peak about 80 minutes postoperative.The proportion of drainage of liquid on total amount every 20 minutes is significant(P<0.05).'Thus,in fact,there is so little,the body's absorption and seepage quantity reached a balance of each patient at this point.At this point,the body is capable of the exudate of neck seep completely absorbed in theory,this also is what we called the risk tube drawing.2.The relationship between operation time and total flowThis experiment operation time can be divided into three groups,respectively is 1 hour,1 to 2 hours,2-3 hours group.The group's total guide flow statistics,each time and total drainage fluid volume ratio and significant difference(p<0.05),thus it is not difficult to see the postoperative patients with along with the growth of the operation time is the total of growth,but when will the 3 compare two sets of data,can be found only within 1 hour group compared with the other two groups there is statistical significance(p<0.05),and the rest two groups to compare when there is no statistical significance(p>0.05),which can get a conclusion,when the operation time in an hour,postoperative patients with total guide flow relative operation time more than an hour of postoperative patients with total flow is less.3.The patient gender and total guide flowAccording to the experimental results,the cases are divided into male and female in the two groups.Among them 10 cases is male patients and 50 cases is female patients.With statistical analysis,the gender have no statistical meaning with total guide flow because of its P value is only 0.481(p>0.05).So the gender haver no meaning on total guide flow after the operation.4.The surgery way and the total flow relationshipAccording to the experimental results,in the fixed range of surgery,compared with the 22 groups,the difference was statistically significant,p>0.05.Because the sample size is small,the increase of the average total flow rate is still needed to be further verified.5.Drainage and drainage of comparisonThere was no postoperative bleeding in all the patients.There were 60 cases of incision effusion in the treatment group,and there were 5 cases in the treatment group(n = 8.3%),and there were only about 44 cases in the treatment group.There were only 9 cases in the control group,the proportion was about 20.5%.The above data were grouped according to the operation time,within 1 hours,1-2 hours group,more than 2 hours group.In 5 cases of the drainage group,the incision effusion occurred in the 1-2 hours group,there was no incision effusion within the group of within 1 hours,1-2 hours group of 42 cases,more than 2 hours in the group of patients.The group did not put the tube:1 hours within the group of effusion in 1 cases,no cases of;1-2 hours of fluid in the group of 7 cases,no cases of more than 2 hours,more than 26 hours in the group of effusion in 1 cases,no cases.The results showed that the cases of wound effusion in the operation time in 1-2 hours group,less than 1 hours group.The relationship between the total operation time and the total flow rate,the operation time in 1 hours or less after the operation can not drain,feasible further experimental exploration.Conclusion:Above all,it is easy to find that each patient all exist a tube drawing point of risk.80 minutes after sugery,body's absorption function and seepage function achieve a balance · At this point drainage tube can be theoretically removed,but the relative risk exists.The opinion is that the new practice for rapid recovery of thyroid surgery and worth to be separated.The patient's gender had no significant effect on the average total drainage volume in a certain range of surgery,the less operation time along with less total drainage and les incision effusion probability.Putting drainage or not need a follow-up study. |
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